Provider Demographics
NPI:1073270583
Name:WETHERHOLT, ALEXANDRA LYNNE (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LYNNE
Last Name:WETHERHOLT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BAYARD RD
Mailing Address - Street 2:
Mailing Address - City:LOTHIAN
Mailing Address - State:MD
Mailing Address - Zip Code:20711-9605
Mailing Address - Country:US
Mailing Address - Phone:410-507-4521
Mailing Address - Fax:
Practice Address - Street 1:3140 W WARD RD STE 203
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3047
Practice Address - Country:US
Practice Address - Phone:410-286-7205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist